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目的：探索选择性脊神经后根切断术（selective posterior rhizotomy, SPR)、外周神经缩窄术、下肢矫形术加康复个性化的组合方式对痉挛性脑瘫的疗效，寻找最佳的综合治疗方案。方法：对2007.2 到2008.11 期间32 例痉挛性脑瘫患者，男24 例，女8 例，平均年龄7.1 岁，完成手术加康复的分段梯度疗法，采用自身前后对照研究。进行治疗前、治疗后脑瘫分项功能评分和脑瘫痉挛临床分项评估以及肌力评价及总体疗效评估。结果：梯度疗法治疗后，脑瘫分项中坐姿、躯干活动、蹲立变换分别是94%、91%和 91%，均有显著性意义；踝阵挛和Babinski 征改善率分别为97.2%和54%。脑瘫分项功能的评分的恢复率均在80%以上。全组疗效优18 例(56.3%)，良12 例(37.5%)，可2 例(6.2%)，优良率93.8%。结论：分度梯度疗法是治疗各种痉挛性脑瘫的有效途径。

英文摘要:

Objective: To seek the best collaboration of the various Personalized combination of the selective posterior rhizotomy (SPR), the peripheral nervous constrictive operation, the lower limbs orthopaedic operation and the rehabilitation training to the spastic cerebral palsy (SCP).Methods:We gained 32 patients of SCP from Feb. 2007 to Nov. 2008. Among them there were 24 male and 8 female, mean of age was 7.1. All the patients accepted the piecewise gradient therapy of operation and rehabilitation. This study adopted before and after treatment control method. The study observed the cerebral palsy partial functional score, the cerebral palsy spasms clinical sub-item evaluation, the muscle evaluation and the overall efficacy. Results: Compared to preoperation, among the cerebral palsy breakdown the sitting posture, the torso activities and the squat made transformation of the postoperation patients had improved significantly and the rates of the improvement were 94%, 91% and 91% accordingly. And the improvement rates of ankle clonus and the Babinski were 97.2% and 54%. The recovery rate of the cerebral palsy sub-item function was above 80%. The curative effect of the whole group were excellent 18 cases (56.3%), fine 12 cases (37.5%), can 2 cases (6.2%). Conclusion: The piecewise gradient therapy is the effective shortcut of the various kinds of spastic cerebral palsy.

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